A team of researchers, who have pioneered novel treatments for post-traumatic stress disorder, were awarded an $ 11 million, four-year grant from the U.S. Department of Defense to investigate the differences between virtual reality and traditional prolonged exposure therapy.

The study, led by Dr. JoAnn Difede at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, will test two different ways to treat PSTD with a total of 300 military and civilian personnel in New York; Washington, D.C.; and Los Angeles.

The study will be located at two clinical sites in addition to NewYork-Presbyterian/Weill Cornell: Dr. Rothbaum is working with the Walter Reed Army Medical Center and National Intrepid Center of Excellence in the Washington, D.C., area; Dr. Rizzo, with the VA Medical Center in Long Beach, California.

“Combat-related PTSD is notoriously difficult to treat. Our study’s large-scale head-to-head investigation of virtual reality compared to traditional exposure treatment for PTSD could answer decisively which intervention is most effective, and for whom,” says Dr. Difede, who directs the Program for Anxiety and Traumatic Stress Studies at NewYork-Presbyterian/Weill Cornell and serves as professor of psychiatry at Weill Cornell Medical College.

“Knowledge we obtain from this clinical trial will help both civilians and military personnel cope with PTSD and could potentially expand the offerings of first-line treatments for this disorder,” she added.

People with this syndrome are haunted by events that happened in their past. This anxiety disorder can develop following a traumatic event, such as war, a car accident, fire or a personal assault. Symptoms include re-experiencing the event, such as through nightmares and flashbacks, avoidance and feelings of numbness and emotional detachment, and hyperarousal such as difficulty sleeping and jumpiness.

Each group of participants will receive two educational sessions followed by seven weekly sessions of exposure therapy-either virtual reality exposure therapy, or prolonged imaginal exposure therapy. Each group will also be randomized to receive a pill containing either the drug D-cycloserine or a placebo prior to exposure therapy sessions.

D-cycloserine, or DCS, is an antibiotic approved by the FDA 50 years ago to treat tuberculosis that has also been found by researchers at Emory to act as a cognitive enhancer. “It can be viewed as a disorder of learning, and this drug seems to facilitate patients’ ability to learn that the trauma is over and the dangerous situation has passed,” Difede says.

The researchers also will search for genetic variants that may make some individuals more vulnerable to developing the malady, as well as which interventions are most likely to succeed. Currently there are no genetic biomarkers for assessing treatment response to any psychiatric disorder, and findings from this study may lead to the development of the first human genetic test that could guide treatment with gene-based therapeutic strategies.

Drs. Difede, Rizzo and Rothbaum have been pioneers, working both separately and collectively in developing virtual reality simulations for the treatment of PTSD. “This grant is the culmination of years of collaborative investigation with Dr. Rothbaum and Dr. Rizzo,” says Dr. Difede. “Our research team is comprised of international leaders in developing and testing virtual reality exposure therapy as well as in the use of DCS.”

“This study could produce needed knowledge that could improve our understanding of the disease and the ways to treat it,” says Dr. Rothbaum. “Predicting which therapy works best for whom will make treatment efforts even more efficient and effective-eventually allowing us to individually tailor treatments.”

To qualify for the study, persons must be active duty military personnel, veterans or civilians who experienced traumatic events while deployed to Iraq or Afghanistan. For more information, interested parties may contact Brittany Mello by calling (212) 821-0783 or by email at brm2016@med.cornell.edu.